Aural and written language elicit the same processes: Further evidence from the missing-phoneme effect.

When readers are asked to detect a target letter while reading for comprehension, they miss it more frequently when it is embedded in a frequent function word than in a less frequent content word. This missing-letter effect has been used to investigate the cognitive processes involved in reading. A similar effect, called the missing-phoneme effect has been found in aural language when participants listen to the narration of a text while searching for a target phoneme. In three experiments, we tested the hypothesis that both effects derived from the same cognitive processes, by isolating the role of word frequency and word function. In Experiment 1, we used a paper and pencil procedure for reading and a continuous narration for the listening task. In Experiments 2 and 3, we used a rapid serial visual or auditory presentation procedure to control for the effects of preprocessing upcoming information: parafoveal processing in reading and coarticulation in aural language processing. Parallel findings were observed in the reading and listening tasks. In all experiments, there was an effect of word function, and there was an effect of word frequency in Experiments 1 and 3. Results are interpreted in light of the attentional disengagement model. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The role of emotion-related individual differences in enjoyment and masking smile judgment.

BACKGROUND: While some research indicates that individuals can accurately judge smile authenticity of enjoyment and masking smile expressions, other research suggest modest judgment rates of masking smiles. The current study explored the role of emotion-related individual differences in the judgment of authenticity and recognition of negative emotions in enjoyment and masking smile expressions as a potential explanation for the differences observed. METHODS: Specifically, Experiment 1 investigated the role of emotion contagion (Doherty in J Nonverbal Behav 21:131-154, 1997), emotion intelligence (Schutte et al. in Personality Individ Differ 25:167-177, 1998), and emotion regulation (Gratz and Roemer in J Psychopathol Behav Assess 26:41-54, 2004) in smile authenticity judgment and recognition of negative emotions in masking smiles. Experiment 2 investigated the role of state and trait anxiety (Spielberger et al. in Manual for the state-trait anxiety inventory, Consulting Psychologists Press, Palo Alto, 1983) in smile authenticity judgment and recognition of negative emotions in the same masking smiles. In both experiments, repeated measures ANOVAs were conducted for judgment of authenticity, probability of producing the expected response, for the detection of another emotion, and for emotion recognition. A series of correlations were also calculated between the proportion of expected responses of smile judgement and the scores on the different subscales. RESULTS: Results of the smile judgment and recognition tasks were replicated in both studies, and echoed results from prior studies of masking smile judgment: participants rated enjoyment smiles as happier than the masking smiles and, of the masking smiles, participants responded "really happy" more often for the angry-eyes masking smiles and more often categorized fear masking smiles as "not really happy". CONCLUSIONS: Overall, while the emotion-related individual differences used in our study seem to have an impact on recognition of basic emotions in the literature, our study suggest that these traits, except for emotional awareness, do not predict performances on the judgment of complex expressions such as masking smiles. These results provide further information regarding the factors that do and do not contribute to greater judgment of smile authenticity and recognition of negative emotions in masking smiles.

Brolucizumab in Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema: Ophthalmology and Diabetology Treatment Aspects.

Anti-vascular endothelial growth factor (anti-VEGF) therapies have become the standard of care in the treatment of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), resulting in a remarkable decrease in disease-related vision loss. However, the need for regular injections places a significant burden on patients, caregivers, and the healthcare system and improvements in vision may not be maintained long term. As a result of its drying potency and duration of action, brolucizumab, an intravitreal anti-VEGF therapy approved for the treatment of nAMD and DME, could decrease injection frequency for patients and provide an efficacious treatment; however, balancing its benefits and risks can be challenging. There have been reports of intraocular inflammation (IOI) in patients treated with brolucizumab, which, if left untreated, may result in severe vision loss. Recent evidence, however, indicates that early recognition of IOI and prompt and aggressive systemic corticosteroid treatment in response to posterior segment involvement can lead to favorable outcomes in these relatively rare but severe cases. A series of consensus meetings were conducted in 2022 between Swiss medical retina experts and diabetologists, discussing the current data for brolucizumab and exploring various challenges to its use, including the associated risk of IOI. The outcome is a collation of practical insights and guidance for ophthalmologists on the use of brolucizumab in patients with nAMD and DME, including patient selection and assessment, treatment regimen and monitoring, and the recognition and management of adverse events.

Cross-sectional comparison of age- and gender-related comorbidities in people living with HIV in Canada.

Because antiretroviral therapy (ART) is allowing people living with human immunodeficiency virus (PLWH) to survive longer, they are developing more age-related comorbidities. We evaluated the effects of age and gender on the burden of age-related comorbidities among PLWH. In this retrospective real-world study, de-identified data were extracted from the medical charts of 2000 HIV-positive adults on ART across 10 sites in Canada. The prevalence of age-related comorbidities was determined in 6 age subgroups (<30, 30-39, 40-49, 50-59, 60-69, and ≥70 years). The effects of gender on these comorbidities were also examined. Risks of cardiovascular disease and chronic kidney disease (CKD) were calculated using the Framingham and D:A:D equations. Most persons were White (68%), male (87%), and virologically suppressed (94%). The mean age was 50.3 years (57% aged ≥50 years), and mean CD4+ T-cell count was 616 cells/mm3. The most common comorbidities were neuropsychiatric symptoms (61%), overweight/obesity (43%), liver disease (37%), and dyslipidemia (37%). The mean number of comorbidities increased across age subgroups (P < .001). Across all age subgroups, the prevalence of hypertension (P = .04), dyslipidemia (P = .04), CKD (P = .03), bone fragility (P = .03), and depression (P = .02) differed between males and females. Both age (P < .001) and gender (P < .001) impacted cardiovascular disease and CKD risk. Age and gender influenced the burden, types, and risks of age-related comorbidities in PLWH in this Canadian cohort. These comorbidities should be diagnosed and treated in routine clinical practice.

Healthcare resource utilization and costs associated with renal, bone and cardiovascular comorbidities among persons living with HIV compared to the general population in Quebec, Canada.

There is limited understanding on healthcare utilization and costs of age-related comorbidities such as cardiovascular, bone and renal disease/disorder in people living with human immunodeficiency virus, so we compared comorbidity prevalence and associated healthcare utilization and costs. Through the Quebec health insurance database, people living with human immunodeficiency virus on antiretroviral therapy for ≥6 months from January 2006 to June 2012 were categorized by their comorbidity status using International Classification of Diseases (ICD)-9 codes, and controls without human immunodeficiency virus diagnosis or antiretroviral therapy use were age and gender matched. We compared healthcare utilization and costs. A total of 3,905 people living with human immunodeficiency virus and 11,715 control individuals were included. The mean age of people living with human immunodeficiency virus was 45.3 years and 77.3% were men. Prevalence of comorbidities was higher and occurred earlier in people living with human immunodeficiency virus and increased with older age regardless of human immunodeficiency virus status. Interestingly, bone comorbidity was high (37%) and 5-fold greater in people living with human immunodeficiency virus <20 years than the controls. Polypharmacy and comorbidity scores were greater in people living with human immunodeficiency virus than controls (p<0.01), as were cardiovascular, bone and renal comorbidities (40.3%, 26.0% and 5.5%, respectively; p<0.01). People living with human immunodeficiency virus had higher healthcare utilization and costs than controls largely due to longer hospital stays and prescriptions. Mean total healthcare cost/person/year for people living with human immunodeficiency virus was CAD$6,248 and was highest for those with renal disease (CAD$19,617). Comorbidities in people living with human immunodeficiency virus are more prevalent, occur earlier and incur a higher burden on the healthcare system; earlier screening and improved preventative and management strategies may reduce the burden to people living with human immunodeficiency virus and to the healthcare system.

A multilingual preregistered replication of the semantic mismatch effect on serial recall.

Visual-verbal serial recall is disrupted when task-irrelevant background speech has to be ignored. Contrary to previous suggestion, it has recently been shown that the magnitude of disruption may be accentuated by the semantic properties of the irrelevant speech. Sentences ending with unexpected words that did not match the preceding semantic context were more disruptive than sentences ending with expected words. This particular instantiation of a deviation effect has been termed the semantic mismatch effect. To establish a new phenomenon, it is necessary to show that the effect can be independently replicated and does not depend on specific boundary conditions such as the language of the stimulus material. Here we report a preregistered replication of the semantic mismatch effect in which we examined the effect of unexpected words in 4 different languages (English, French, German, and Swedish) across 4 different laboratories. Participants performed a serial recall task while ignoring sentences with expected or unexpected words that were recorded using text-to-speech software. Independent of language, sentences ending with unexpected words were more disruptive than sentences ending with expected words. In line with previous results, there was no evidence of habituation of the semantic mismatch effect in the form of a decrease in disruption with repeated exposure to the occurrence of unexpected words. The successful replication and extension of the effect to different languages indicates the expression of a general and robust mechanism that reacts to violations of expectancies based on the semantic content of the irrelevant speech. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Canadian French Translation and Preliminary Validation of the Conformity to Masculine Norms Inventory: A Pilot Study.

Conformity to masculine norms has been linked to poor mental and physical health outcomes. Its valid assessment among subgroups of the population is therefore a crucial step in the investigation of intercultural variability in the enactment of masculinity, as well as its causes, costs, and benefits. The present pilot study aimed to adapt and conduct a preliminary validation of a French version of the Conformity to Masculine Norms Inventory (CMNI-22), a self-report questionnaire designed to assess overall conformity to male gender standards. The French adaptation of the CMNI-22 (CanFr-CMNI-22) was developed using a forward-backward translation process. The data from a sample of 57 Canadian French men (23-81 years old), collected at two time points 2 weeks apart, were then analyzed to investigate the psychometric properties and factor structure of the CanFr-CMNI-22. Findings indicated adequate internal reliability of the global scores and highly satisfactory test-retest reliability. Correlations with the Male Role Norms Inventory-Short Form (MRNI-SF) at both time points also showed strong convergent validity. Overall, the CanFr-CMNI-22 appears to be a reliable and valid instrument to assess conformity to traditional masculine gender norms in French-speaking men from the general population. This study is a key step in a research process aiming to validate the Canadian French version of the CMNI and contributes to enhance inclusive research and clinical care to foster men's health.

A round Bouba is easier to remember than a curved Kiki: Sound-symbolism can support associative memory.

Past research has shown that prior knowledge can support our episodic memory for recently encountered associations. According to the model proposed by Cox and Criss (Proceedings of the 40th Annual Conference of the Cognitive Science Society, pp. 250-255, Madison, MI: Cognitive Science Society, 2018) and Cox and Shiffrin (Cognitive Psychology, 97, 31-61, 2017), any features shared by associated items should facilitate encoding and retrieval. We implemented a strict test of this prediction by taking advantage of sound-symbolism associations; here, the latter refer to relationships between phonemes and object characteristics - relationships that participants readily find natural - even if they have never encountered the items before. For instance, the non-word "maluma" is much more readily seen to refer to a random shape with rounded contours than to a shape that has sharp angles. In our study, 70 participants completed paired-associate memory tests after studying lists of three pairs, each composed of a random shape and a non-word. As predicted, there was better associative memory performance for sound-shape pairs that could rely on sound-symbolism links.

Back to the Future: Penicillin-Susceptible Staphylococcus aureus.

BACKGROUND: Widespread penicillin usage rapidly resulted in the emergence of penicillin resistance in Staphylococcus aureus. However, new data suggest that penicillin susceptibility may be in a period of renaissance. The objective of our study was to quantify penicillin resistance in methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. METHODS: We retrospectively reviewed all adult MSSA bacteremia from April 2010 to April 2015 at the McGill University Health Centre (Montreal, QC, Canada). Susceptibility to penicillin, erythromycin, clindamycin, and trimethoprim-sulfamethoxazole (TMP-SMX) was determined in accordance with the Clinical & Laboratory Standards Institute guidelines. RESULTS: There were 324 unique episodes of MSSA bacteremia. Ninety (28%) isolates were susceptible to penicillin, 229 (71%) to erythromycin, 239 (74%) to clindamycin, and 317 (98%) to TMP-SMX. Isolates that were penicillin resistant were more likely to also be resistant to other antibiotics, but a statistically significant association was apparent only for erythromycin resistance (76/234, 32.2% vs 19/90, 21.1%, P = .04). The median age of patients was 67.5 years (interquartile range 52-78) and overall in-hospital 30-day mortality was 16.3% (53 deaths). After adjustment for patient age, there was no association between penicillin resistance and either intensive care unit admission or death. CONCLUSION: More than one-quarter of patients with MSSA bacteremia potentially could be treated with parenteral penicillin, which may offer pharmacokinetic advantages over other beta-lactam drugs and potentially improved outcomes.

DDX17 promotes the production of infectious HIV-1 particles through modulating viral RNA packaging and translation frameshift.

RNA helicases are a large family of proteins that rearrange RNA structures and remodel ribonucleic protein complexes using energy derived from hydrolysis of nucleotide triphosphates. They have been shown to participate in every step of RNA metabolism. In the past decade, an increasing number of helicases were shown to promote or inhibit the replication of different viruses, including human immunodeficiency virus type 1. Among these helicases, the DEAD-box RNA helicase DDX17 was recently reported to modulate HIV-1 RNA stability and export. In this study, we further show that the helicase activity of DDX17 is required for the production of infectious HIV-1 particles. Over expression of the DDX17 mutant DQAD in HEK293 cells reduces the amount of packaged viral genomic RNA and diminishes HIV-1 Gag-Pol frameshift. Altogether, these data demonstrate that DDX17 promotes the production of HIV-1 infectious particles by modulating HIV-1 RNA metabolism.

Pneumocystis jirovecii genotype associated with increased death rate of HIV-infected patients with pneumonia.

Pneumocystis jirovecii dihydropteroate synthase (DHPS) mutations have been associated with failure of sulfa prophylaxis; their effect on the outcome of patients with P. jirovecii pneumonia (PCP) remains controversial. P. jirovecii DHPS polymorphisms and genotypes were identified in 112 cases of PCP in 110 HIV-infected patients by using PCR single-strand conformation polymorphism. Of the 110 patients observed, 21 died; 18 of those deaths were attributed to PCP. Thirty-three percent of the PCP cases involved a P. jirovecii strain that had 1 or both DHPS mutations. The presence or absence of DHPS mutations had no effect on the PCP mortality rate within 1 month, whereas P.jirovecii type 7 and mechanical ventilation at PCP diagnosis were associated with an increased risk of death caused by PCP. Mechanical ventilation at PCP diagnosis was also associated with an increased risk of sulfa treatment failure at 5 days.

Two new species of scalpelliform barnacles (Cirripedia: Thoracica) from the Plio-Pleistocene of Cotentin, northwest France.

Two new species of pedunculate cirripede are described from the Plio-Pleistocene of Cotentin, northwest France. Scalpellum carentanensis sp. nov. is only the third species of this genus to be recorded from Pliocene strata in Europe. It is characterised by a triangular tergum with an apico-basal fold, without an outward extension, the inner surface of which has the raised part marked by wide growth lines, cut by a groove; the scutum has a ridge between the umbo and the tergo-lateral angle, lacks an apico-basal ridge, and possesses a line formed by the convergence of the growth zones; the length of the upper lateral exceeds its width by about 1.25 times, the umbo being situated at one-fifth the length of the plate from the apex. Arcoscalpelluin concavitectum sp. nov. is the second species of this genus on record from the Pliocene of Europe. It possesses a carina with a concave tectum bordered on each side by a smooth rounded rib; the tergum has an apico-basal line formed by the convergence of growth zones; and the upper lateral has the basi-scutal angle more widely truncated than the basi-tergal angle.

From promoting to inhibiting: diverse roles of helicases in HIV-1 Replication.

Helicases hydrolyze nucleotide triphosphates (NTPs) and use the energy to modify the structures of nucleic acids. They are key players in every cellular process involving RNA or DNA. Human immunodeficiency virus type 1 (HIV-1) does not encode a helicase, thus it has to exploit cellular helicases in order to efficiently replicate its RNA genome. Indeed, several helicases have been found to specifically associate with HIV-1 and promote viral replication. However, studies have also revealed a couple of helicases that inhibit HIV-1 replication; these findings suggest that HIV-1 can either benefit from the function of cellular helicases or become curtailed by these enzymes. In this review, we focus on what is known about how a specific helicase associates with HIV-1 and how a distinct step of HIV-1 replication is affected. Despite many helicases having demonstrated roles in HIV-1 replication and dozens of other helicase candidates awaiting to be tested, a deeper appreciation of their involvement in the HIV-1 life cycle is hindered by our limited knowledge at the enzymatic and molecular levels regarding how helicases shape the conformation and structure of viral RNA-protein complexes and how these conformational changes are translated into functional outcomes in the context of viral replication.

Comparison of eight commercial enzyme immunoassays for the detection of Clostridium difficile from stool samples and effect of strain type.

We compared the performance of 8 Clostridium difficile enzyme immunoassays to cell cytotoxicity neutralization assay and toxigenic culture. The effect of strain type on assay performance was also examined. There were a total of 71 (14.4%) samples in which C. difficile was recovered; 58 (81.7%) of 71 were toxigenic. Compared to a composite reference standard of either C. difficile cytotoxin assay positive or toxigenic C. difficile culture positive, the sensitivities of these assays varied from 31.7% to 55.2%, while the specificities were excellent, ranging from 98.1% to 100%. Among the 57 C. difficile isolates, 30 (51.7%) were of the NAP1 genotype. Stool samples positive for the C. difficile NAP1 strain had a higher positivity rate for the toxin assays.

The transmembrane domain of BST-2 determines its sensitivity to down-modulation by human immunodeficiency virus type 1 Vpu.

Bone marrow stromal cell antigen 2 (BST-2, also known as tetherin) restricts the production of a number of enveloped viruses by blocking virus release from the cell surface. This antiviral activity is counteracted by such viral factors as Vpu of human immunodeficiency virus type 1 (HIV-1). Here, we report that Vpu antagonizes human BST-2 but not BST-2 derived from African green monkeys. The determinants of susceptibility to Vpu map to the transmembrane domain of BST-2. In accordance with this, expression of human BST-2 containing a modified transmembrane domain effectively blocks the replication of wild-type Vpu-expressing HIV-1 in CD4+ T cells. Furthermore, these BST-2 variants, as opposed to wild-type human BST-2, are refractory to Vpu-mediated down-regulation as a result of an attenuated interaction with Vpu. In view of the work by others pointing to a key role of the transmembrane domain of Vpu in promoting virus release, our data suggest that a direct interaction through the transmembrane domain of each of these two proteins is a prerequisite for Vpu to down-modulate BST-2.

Prediction of the virological response to etravirine in clinical practice: Comparison of three genotype algorithms.

The current Agence Nationale de Recherche sur le SIDA (ANRS)/International AIDS Society (IAS) algorithm predicts resistance to etravirine for viruses harboring >/=3 mutations from a list of 13 reverse transcriptase (RT) mutations. Two weighted algorithms, best correlated with fold changes to etravirine, have been described recently. A retrospective virological analysis of a major French city HIV sequences database was undertaken to assess the proportion of etravirine resistant viruses according to these three algorithms and the correlations between them. Two thousand six hundred eighty RT sequences were analyzed, including 749 from naive patients and 926 from patients previously treated with non-nucleoside reverse transcriptase inhibitor (NNRTI). Combinations of mutations associated with etravirine resistance according to the three algorithms were found in 0%, 2.3%, and 3.6% of naive patients, and in 2.4%, 20.4%, and 19.3% of patients previously treated with NNRTIs. Concordance between the algorithms was weak (2 x 2 Kendall's tau: 0.787, 0.395, and 0.584). Most of the discordance was due to the differential weights attributed to Y181C/V, L100I, and K101P in the two weighted algorithms. It is concluded that the current ANRS/ IAS algorithm probably underestimates the proportion of viruses partially resistant to etravirine in NNRTI-experienced patients. Improvements in algorithms are needed to take into account the partial resistance associated with some mutation patterns, and should include either additional mutations to the current list and/or differential weights for specific mutations. Surveys of naive patients should be conducted to estimate the risk of primary resistance to etravirine in a minority of cases.

Mycobacterium haemophilum epididymal abscess in a renal transplant patient.

Mycobacterium haemophilum is an established cause of cutaneous lesions in immunocompromised hosts. We report the first known case of epididymal abscess, which highlights the need to work up all specimens that are acid-fast bacillus-positive for M. haemophilum from immunocompromised hosts, regardless of body site.

Epidemiology and antifungal susceptibility of bloodstream Candida isolates in Quebec: Report on 453 cases between 2003 and 2005.

BACKGROUND: Between May 2003 and April 2005, a population-based surveillance of Candida bloodstream infections was conducted in Quebec. A total of 453 episodes of candidemia (464 yeast isolates) from 54 participating hospitals were studied. RESULTS: The annual incidence rate was three per 100,000 population. Global hospital mortality was 38%. The most common predisposing factors were the presence of an intravascular catheter (80%), use of antibacterial therapy (67%), stay in an intensive care unit (49%), use of parenteral nutrition (32%) and intra-abdominal surgery (31%). Fluconazole alone or in association with other antifungals was used for treatment in over 80% of cases. Candida albicans comprised 62% of isolates, followed by Candida glabrata (17%), Candida parapsilosis (9%), Candida tropicalis (5%), Candida lusitaniae (3%) and Candida krusei (3%). Of the 288 C albicans isolates, seven (2%) were resistant to flucytosine, one to fluconazole and none to itraconazole or voriconazole. Of the 75 non-C albicans species isolates with reduced susceptibility to fluconazole (minimum inhibitory concentration [MIC] 16 mug/mL or greater), none were susceptible to itraconazole (MIC 0.12 mg/L or lower), whereas 71 (95%) were susceptible to voriconazole (MIC 1 mug/mL or lower). However, only five of 12 (42%) fluconazole-resistant isolates were susceptible to voriconazole. Posaconazole, ravuconazole and caspofungin displayed a broad spectrum of activity against these isolates, with MICs of 1 mg/L or lower in 56%, 92% and 100% of isolates, respectively. Overall, a correlation (r(2)>0.87) was observed among increasing fluconazole MICs and the geometric mean MICs of itraconazole, voriconazole, posaconazole and ravuconazole. CONCLUSIONS: These surveillance results when compared with those of the 1993 to 1995 survey confirm little variation in the distribution of species causing invasive Candida infection over a 10-year period in Quebec, as well as the continuous excellent overall in vitro activity of fluconazole.

A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality.

BACKGROUND: In March 2003, several hospitals in Quebec, Canada, noted a marked increase in the incidence of Clostridium difficile-associated diarrhea. METHODS: In 2004 we conducted a prospective study at 12 Quebec hospitals to determine the incidence of nosocomial C. difficile-associated diarrhea and its complications and a case-control study to identify risk factors for the disease. Isolates of C. difficile were typed by pulsed-field gel electrophoresis and analyzed for binary toxin genes and partial deletions in the toxin A and B repressor gene tcdC. Antimicrobial susceptibility was evaluated in a subgroup of isolates. RESULTS: A total of 1703 patients with 1719 episodes of nosocomial C. difficile-associated diarrhea were identified. The incidence was 22.5 per 1000 admissions. The 30-day attributable mortality rate was 6.9 percent. Case patients were more likely than matched controls to have received fluoroquinolones (odds ratio, 3.9; 95 percent confidence interval, 2.3 to 6.6) or cephalosporins (odds ratio, 3.8; 95 percent confidence interval, 2.2 to 6.6). A predominant strain, resistant to fluoroquinolones, was found in 129 of 157 isolates (82.2 percent), and the binary toxin genes and partial deletions in the tcdC gene were present in 132 isolates (84.1 percent). CONCLUSIONS: A strain of C. difficile that was resistant to fluoroquinolones and had binary toxin and a partial deletion of the tcdC gene was responsible for this outbreak of C. difficile-associated diarrhea. Exposure to fluoroquinolones or cephalosporins was a risk factor.

Virologic and immunologic response to a boosted double-protease inhibitor-based therapy in highly pretreated HIV-1-infected patients.

PURPOSE: To assess the virologic and immunologic response to a boosted double-protease inhibitor (PI) regimen of highly pretreated patients infected with HIV-1 and to examine the role of PI resistance and concentration of serum saquinavir. METHOD: In an open-label prospective study, lopinavir/ritonavir, saquinavir-sgc, lamivudine, and other nucleoside analogues were offered to highly pretreated patients who had advanced HIV-1 infection and who had failed at least 2 previous highly active antiretroviral therapy regimens including at least 1 nonnucleoside reverse transcriptase inhibitor. The relationship between baseline drug resistance and steady-state saquinavir serum levels and early (week 4) and sustained (week 48) virologic response was documented. RESULTS: 35 advanced HIV-1 patients were enrolled. The boosted double-PI regimen was well tolerated. Twenty-two (63%) of the 35 patients had a > 0.8 log(10) decrease in HIV viral load at week 4. After 48 weeks of follow-up, the 22 patients who remained on the study therapy had an average decrease in viral load of 1 log(10) and had a median increase in CD4 cells of 60 cell/microL. Multiple logistic regression analysis indicated that genotypic resistance to both PIs and the week-3 trough concentrations of saquinavir were associated with virologic outcome at week 4. The presence of > or = 6 lopinavir mutations [odds ratio (OR) 0.03; 95% CI 0.01 to 0.79] and the 48V mutation (OR 0.01; 95%CI <0.01 to 0.88) was independently associated with lower odds of achieving an early response, whereas a higher saquinavir concentration at week 3 (OR 8.36; 95% CI 1.28 to 54.70) was associated with greater odds of an early response. CONCLUSION: These findings suggest that baseline PI resistance and saquinavir concentration were associated with virologic response and should be considered when planning salvage therapy.